Photo Credit - Ministry of Health of the Kingdom of Cambodia
# 8364
Although it has yet to appear on the Cambodian MOH website, overnight the United Nations in Cambodia posted the following Joint Press Release From the Ministry of Health, Kingdom of Cambodia, and the World Health Organization (WHO) on the two H5N1 cases widely reported in the media Sunday night (see Cambodia: Media Reports Two New H5N1 Cases (1 Fatal)).
7th and 8th New Human Cases of Avian Influenza H5N1 in Cambodia in 2014
Joint Press Release From the Ministry of Health, Kingdom of Cambodia, and the World Health Organization (WHO)
Phnom Penh, 11 March 2014
The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that two (2) new human cases of avian influenza have been confirmed for the H5N1 virus. This is the 7th and 8th cases this year and the 54th and 55th persons to become infected with the H5N1 virus in Cambodia. The cases are from Kandal and Kampong Chnnang provinces. Of the 55 confirmed cases, 43 were children under 14, and 29 of the 55 were female. In addition, since the first case happened in Cambodia in 2005 there were 19 cases survived.
The 7th case, an 8-year-old boy from Spean-Dek village, Prek-TunLoab commune, Leuk-Dek district, Kandal province, was tested positive by Institut Pasteur du Cambodge on the 6th March 2014. The boy had onset symptoms of fever, chill, running nose, sore throat, and cough on 24th February 2014. His parents sought treatment at a private practitioner in the village on the same day. His condition worsened and the boy was admitted to Kantha Bopha Hospital on 4th March. On 4th March, the boy had symptoms of fever, chill, running nose, sore throat, cough, dyspnoea, convulsion and somnolence. The specimen was collected on 5th March and Tamiflu was administered on the same day. The boy is recovering.
Around mid-February, about 90% of poultries died in the village. Chickens died in the case’s house and the family buried them. There is also a poultry slaughter’s house near to the case’s house. The parents reported that the boy had no direct contact but the chickens died in close proximity.
The 8th case, an 11-year-old boy from Toeuk Laak village, Toeuk Haut commune, Rolea Paear district, Kampong Chnnang province, was tested positive by Institut Pasteur du Cambodge on the 6th March 2014. The boy had onset symptoms of fever and headache on 3rd March 2014. His parents sought treatment at a private practitioner next to their house on the same day and on the next day (4th March). His condition worsened and the boy was admitted to Kampong Chnnang Provincial Hospital on 5th March. On 6th March, the boy had symptoms of fever, cough, and shortness of breath and was referred to Kantha Bopha Hospital in the afternoon on the same day. The boy died a few hours after his admission on 6th March.
Beginning of February, chickens started dying in the village and in the case’s house and continued for a month. The boy helped to prepare dead chickens and ducks for food and ate them.
The Ministry of Health’s National and local Rapid Response Teams (RRTs) are conducting outbreak investigation and responses following the national protocol.
This statement also includes details on their ongoing public education campaign on H5N1 safety, promoting the messages - wash hands often with soap and water, before eating and after coming into contact with poultry; keep children away from poultry; keep poultry away from living areas; do not eat dead or sick poultry; and all poultry eaten should be well cooked.
It also updates the MOH’s statement on the dangers of H5N1:
"Avian influenza H5N1 remains a serious threat to the health of all Cambodians and more so for children, who seem to be most vulnerable and are at high risk. There have been 55 cases of H5N1 infection in humans since 2005 and here are the seventh and eight cases of this year. Children often care for domestic poultry by feeding them, cleaning pens and gathering eggs. Children may also have closer contact with poultry as they often treat them as pets and also seem to be most vulnerable and are at high risk because they like to play where poultry are found. I urge parents and guardians to keep children away from sick or dead poultry and prevent them from playing with chickens and ducks. Parents and guardians must also make sure children thoroughly wash their hands with soap and water before eating and after any contact with poultry. Hands may carry the virus that cannot be seen by the naked eye. Soap washes away the virus on hands. If children have fast or difficult breathing, their parents should seek medical attention at the nearest health facility and attending physicians must be made aware of any exposure to sick or dead poultry,” said H.E. Dr. Mam Bunheng, Minister of Health.
Although we’ve seen 45 cases reported in Cambodia since this uptick began three years ago (see 2011’s Cambodia’s Bird Flu Risk "under control" – Experts), they continue to emerge sporadically, and from numerous and widespread provinces across the country.
We’ve seen a few clusters (see Cambodia: 2 Deaths - 1 Confirmed H5N1, 1 Probable), but no signs of sustained or efficient human-to-human transmission.
By the same token, the fact that the virus has been acquired (presumably from infected chickens & ducks) across wide swaths of their nation in recent years speaks to how prevalent the virus apparently has become in Cambodia’s poultry.
While renewed public awareness campaigns have been mounted, that message is likely lost on a population to whom hunger, malaria, dengue, and diarrheal diseases take a much greater toll. Add in rising food prices and growing food insecurity, and the odds that families follow the government’s advice to `not eat dead or sick poultry’ is probably pretty low.
The good news, so far at least, is that the H5N1 bird flu virus remains primarily an avian-adapted virus. It only rarely infects humans, and human-to-human transmission is even rarer still.
As with H7N9, H10N8, H9N2 (and a short list of other novel flu viruses) the concern remains that given enough opportunities, one of these viruses might better adapt to human physiology and someday pose a pandemic threat.
